1
|
Matlock KA, Broadley M, Hendrieckx C, Clowes M, Sutton A, Heller SR, de Galan BE, Pouwer F, Speight J. Changes in quality of life following hypoglycaemia in adults with type 2 diabetes: A systematic review of longitudinal studies. Diabet Med 2022; 39:e14706. [PMID: 34596292 PMCID: PMC9293422 DOI: 10.1111/dme.14706] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Accepted: 09/28/2021] [Indexed: 12/21/2022]
Abstract
AIM To conduct a systematic review of published studies reporting on the longitudinal impacts of hypoglycaemia on quality of life (QoL) in adults with type 2 diabetes. METHOD Database searches with no restrictions by language or date were conducted in MEDLINE, Cochrane Library, CINAHL and PsycINFO. Studies were included for review if they used a longitudinal design (e.g. cohort studies, randomised controlled trials) and reported on the association between hypoglycaemia and changes over time in patient-reported outcomes related to QoL. RESULTS In all, 20 longitudinal studies published between 1998 and 2020, representing 50,429 adults with type 2 diabetes, were selected for review. A descriptive synthesis following Synthesis Without Meta-analysis guidelines indicated that self-treated symptomatic hypoglycaemia was followed by impairments in daily functioning along with elevated symptoms of generalised anxiety, diabetes distress and fear of hypoglycaemia. Severe hypoglycaemic events were associated with reduced confidence in diabetes self-management and lower ratings of perceived health over time. Frequent hypoglycaemia was followed by reduced energy levels and diminished emotional well-being. There was insufficient evidence, however, to conclude that hypoglycaemia impacted sleep quality, depressive symptoms, general mood, social support or overall diabetes-specific QoL. CONCLUSIONS Longitudinal evidence in this review suggests hypoglycaemia is a common occurrence among adults with type 2 diabetes that impacts key facets in the physical and psychological domains of QoL. Nonetheless, additional longitudinal research is needed-in particular, studies targeting diverse forms of hypoglycaemia, more varied facets of QoL and outcomes assessed using hypoglycaemia-specific measures.
Collapse
Affiliation(s)
- Kevin A. Matlock
- Psychology DepartmentUniversity of Southern DenmarkOdenseDenmark
| | - Melanie Broadley
- Psychology DepartmentUniversity of Southern DenmarkOdenseDenmark
| | - Christel Hendrieckx
- Australian Centre for Behavioural Research in DiabetesMelbourneVictoriaAustralia
| | - Mark Clowes
- School of Health and Related ResearchUniversity of SheffieldSheffieldUK
| | - Anthea Sutton
- School of Health and Related ResearchUniversity of SheffieldSheffieldUK
| | - Simon R. Heller
- Sheffield Teaching Hospitals Foundation TrustSheffieldUK
- Department of Oncology and MetabolismUniversity of SheffieldSheffieldUK
| | - Bastiaan E. de Galan
- Department of Internal MedicineRadboud University Nijmegen Medical CentreNijmegenThe Netherlands
- Division of EndocrinologyDepartment of Internal MedicineMaastricht University Medical CentreMaastrichtThe Netherlands
- CARIM School for Cardiovascular DiseasesMaastricht UniversityMaastrichtThe Netherlands
| | - Frans Pouwer
- Psychology DepartmentUniversity of Southern DenmarkOdenseDenmark
- Steno Diabetes CenterOdenseDenmark
| | - Jane Speight
- Australian Centre for Behavioural Research in DiabetesMelbourneVictoriaAustralia
| | | |
Collapse
|
2
|
Lapolla A, Genovese S, Giorgino F, Disoteo O, Sartore G, Bartezaghi M, Del Prato S. Patient-reported outcomes in elderly patients with type 2 diabetes mellitus treated with dual oral therapy: a multicenter, observational study from Italy. Curr Med Res Opin 2020; 36:555-562. [PMID: 31868033 DOI: 10.1080/03007995.2019.1707649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Objective: To assess patient-reported outcomes after two years of use of dual oral anti-diabetes drug (OAD) therapy in elderly people (≥65 years) with type 2 diabetes mellitus (T2DM) from Italy under real-life settings.Methods: 3-AGE was a prospective, non-interventional study in elderly people with T2DM inadequately controlled on metformin monotherapy (defined as glycated hemoglobin [HbA1c] 7.0-9.0%), in whom a second OAD was prescribed. Primary endpoint was to assess the physical and psychological symptoms associated with T2DM from baseline to 24 months using the Diabetes Symptom Check List revised (DSC-R) questionnaire. Patient's quality of life and health status, treatment satisfaction, consumption of healthcare resources, and physician satisfaction with treatment were also assessed (secondary endpoints) using validated questionnaires. Additionally, safety and clinical characteristics were also evaluated.Results: The mean age of the study population (N = 860) was 71.5 ± 5.2 years. Addition of a second OAD significantly (p < .0001) reduced the DSC-R score from baseline (0.73 ± 0.68) to both Months 12 and 24 (0.63 ± 0.59 and 0.61 ± 0.56), and HbA1c from baseline (7.72% ± 0.54%) to Month 12 (6.95% ± 0.82%). Adding a second OAD improved quality of life and health status (baseline, 71.31 ± 15.16 to Month 12, 74.49 ± 13.64; p < .0001), patient's treatment satisfaction (p < .0001), and consumption of healthcare resources per patient. Physicians expressed good satisfaction with patients' treatment (across efficacy, tolerability and compliance domains) at Month 12. Overall, 32 adverse reactions (in 24 patients) and four hypoglycemic episodes were reported during the 24 months.Conclusion: Addition of a second OAD improved physical and psychological symptoms associated with T2DM and was well tolerated in elderly people under real-life settings.
Collapse
Affiliation(s)
| | - Stefano Genovese
- Diabetes, Endocrine and Metabolic Diseases Unit, Centro Cardiologico Monzino IRCCS, Milan, Italy
| | - Francesco Giorgino
- Department of Emergency and Organ Transplantation, University of Bari Aldo Moro, Bari, Italy
| | - Olga Disoteo
- Diabetes Unit, Niguarda Cà Granda Hospital, Milan, Italy
| | | | | | - Stefano Del Prato
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| |
Collapse
|
3
|
Stojanović M, Cvetanović G, Anđelković Apostolović M, Stojanović D, Rančić N. Impact of socio-demographic characteristics and long-term complications on quality of life in patients with diabetes mellitus. Cent Eur J Public Health 2018; 26:104-110. [PMID: 30102498 DOI: 10.21101/cejph.a5022] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2016] [Accepted: 05/14/2018] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Diabetes mellitus (DM) has been one of the leading chronic diseases worldwide over past decades. The objective of the study was to identify predictors associated with health-related quality of life (HRQOL) in diabetic patients. METHODS A cross-sectional questionnaire-based study was conducted at the General Hospital of the city of Leskovac, between June and November 2015. The Short Form-36 (SF-36) questionnaire, EuroQol-5D (EQ-5D) and EuroQol-VAS (EQ-VAS) questionnaires were used. Univariate and multivariate linear regression analyses were performed. RESULTS The total number of patients was 285, 112 men (39.3%) and 173 women (60.7%), average age 63.92 ± 1.07 years. The results of multiple linear regression of socio-demographic characteristics in relation to dimensions of the quality of life measured by SF-36 and EQ-VAS showed that age, country (rural) life, low level of education, retirement, and poor economic status are predictors of lower quality of life. Our results showed that employment has a significant association with higher Physical Component Score (PCS), Mental Component Score (MCS) and EQ-VAS score, which can be explained with higher incomes, improved economic status and less possibility for the occurrence of depressive mood. Patients without formal education have lower QOL. Univariate multiple regression analysis of the presence of micro- and macrovascular complications of DM showed that angina pectoris, heart failure, diabetic retinopathy, and diabetic nephropathy are the most important factors affecting the quality of life in our population. After including the multivariate model, all tested complications remained statistically significant. CONCLUSION Our results showed that both socioeconomic and chronic complications are relevant factors of HRQOL in type 1 and 2 diabetes mellitus patients. Age, rural lifestyle, retirement, lower level of education and low socioeconomic status, as well as DM complications (angina pectoris, hearth failure, diabetes nephropathy, and diabetes retinopathy) were found to be independent risk factors for the component scores of SF-36 and EQ-VAS score. Taking into consideration the results obtained, health practitioners should be aware not only of the clinical parameters of patients with DM, but also of their educational level and working status.
Collapse
Affiliation(s)
- Miodrag Stojanović
- University of Niš, Faculty of Medicine Niš, Niš, Serbia.,Department of Biostatistics, Institute for Public Health, Niš, Serbia
| | | | - Marija Anđelković Apostolović
- University of Niš, Faculty of Medicine Niš, Niš, Serbia.,Department of Biostatistics, Institute for Public Health, Niš, Serbia
| | | | - Nataša Rančić
- University of Niš, Faculty of Medicine Niš, Niš, Serbia.,Centre for Control and Prevention of Diseases, Institute of Public Health, Niš, Serbia
| |
Collapse
|
4
|
Agiostratidou G, Anhalt H, Ball D, Blonde L, Gourgari E, Harriman KN, Kowalski AJ, Madden P, McAuliffe-Fogarty AH, McElwee-Malloy M, Peters A, Raman S, Reifschneider K, Rubin K, Weinzimer SA. Standardizing Clinically Meaningful Outcome Measures Beyond HbA 1c for Type 1 Diabetes: A Consensus Report of the American Association of Clinical Endocrinologists, the American Association of Diabetes Educators, the American Diabetes Association, the Endocrine Society, JDRF International, The Leona M. and Harry B. Helmsley Charitable Trust, the Pediatric Endocrine Society, and the T1D Exchange. Diabetes Care 2017; 40:1622-1630. [PMID: 29162582 PMCID: PMC5864122 DOI: 10.2337/dc17-1624] [Citation(s) in RCA: 262] [Impact Index Per Article: 37.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To identify and define clinically meaningful type 1 diabetes outcomes beyond hemoglobin A1c (HbA1c) based upon a review of the evidence, consensus from clinical experts, and input from researchers, people with type 1 diabetes, and industry. Priority outcomes include hypoglycemia, hyperglycemia, time in range, diabetic ketoacidosis (DKA), and patient-reported outcomes (PROs). While priority outcomes for type 1 and type 2 diabetes may overlap, type 1 diabetes was the focus of this work. RESEARCH AND METHODS A Steering Committee-comprising representatives from the American Association of Clinical Endocrinologists, the American Association of Diabetes Educators, the American Diabetes Association, the Endocrine Society, JDRF International, The Leona M. and Harry B. Helmsley Charitable Trust, the Pediatric Endocrine Society, and the T1D Exchange-was the decision-making body for the Type 1 Diabetes Outcomes Program. Their work was informed by input from researchers, industry, and people with diabetes through Advisory Committees representing each stakeholder group. Stakeholder surveys were used to identify priority outcomes. The outcomes prioritized in the surveys were hypoglycemia, hyperglycemia, time in range, DKA, and PROs. To develop consensus on the definitions of these outcomes, the Steering Committee relied on published evidence, their clinical expertise, and feedback from the Advisory Committees. RESULTS The Steering Committee developed definitions for hypoglycemia, hyperglycemia, time in range, and DKA in type 1 diabetes. The definitions reflect their assessment of the outcome's short- and long-term clinical impact on people with type 1 diabetes. Knowledge gaps to be addressed by future research were identified. The Steering Committee discussed PROs and concluded that further type 1 diabetes-specific development is needed. CONCLUSIONS The Steering Committee recommends use of the defined clinically meaningful outcomes beyond HbA1c in the research, development, and evaluation of type 1 diabetes therapies.
Collapse
Affiliation(s)
| | | | | | - Lawrence Blonde
- American Association of Clinical Endocrinologists, Jacksonville, FL
| | | | | | | | - Paul Madden
- American Diabetes Association, Arlington, VA
| | | | | | | | - Sripriya Raman
- American Association of Clinical Endocrinologists, Jacksonville, FL
| | | | | | | |
Collapse
|
5
|
Lin CY, Lee TY, Sun ZJ, Yang YC, Wu JS, Ou HT. Development of diabetes-specific quality of life module to be in conjunction with the World Health Organization quality of life scale brief version (WHOQOL-BREF). Health Qual Life Outcomes 2017; 15:167. [PMID: 28835235 PMCID: PMC5569515 DOI: 10.1186/s12955-017-0744-3] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2016] [Accepted: 08/16/2017] [Indexed: 12/26/2022] Open
Abstract
Background Although numerous health-related quality of life (HRQoL) instruments are available for patients with diabetes, the length of these measures may limit their feasibility to routine practice. Also, these measures do not distinguish items for generic and diabetes-specific HRQoL. This study was aimed to develop a diabetes-specific quality of life questionnaire module (DMQoL) to be in conjunction with the World Health Organization Quality of Life scale brief version (WHOQOL-BREF). Methods One hundred seventeen patients with diabetes were enrolled from a medical center in Taiwan. The item content of DMQoL was constructed based on an extensive review of existing HRQoL instruments for diabetes, expert discussions and patient interviews. A series of psychometric tests were conducted to ensure the reliability and validity of DMQoL. The WHOQOL-BREF served as an existing HRQoL measure for construct validity testing. The response scale of DMQoL was adopted from the 5-point Likert scale of WHOQOL-BREF. Results A total of 10 items without ceiling or floor effects were selected from 20 items. Exploratory factor analysis (EFA) with parallel analysis and Rasch analysis concluded that the 10 items were embedded in the same underlying concept. The corrected item-total correlations and factor loadings from EFA were all above 0.4. The internal consistency of the 10 items was satisfactory (Cronbach’s α = 0.84). The DMQoL total score was moderately correlated with that of WHOQOL-BREF (r = 0.48, p < 0.001). The known-group validity showed that patients with HbA1c ≤ 7% had significantly higher mean scores of DMQoL than did those with HbA1c > 8% (3.66 ± 0.47 vs. 3.41 ± 0.53; p = 0.037). Conclusions The DMQoL with only 10 items is developed and it is sensitive to the change of diabetes progression in early phases (e.g., glycemic changes). The combination of WHOQOL-BREF and DMQoL provides a comprehensive picture of overall HRQoL in patients with diabetes and enhance the instrument’s ability to detect clinically meaningful changes in diabetes. Electronic supplementary material The online version of this article (doi:10.1186/s12955-017-0744-3) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Chung-Ying Lin
- Department of Rehabilitation Sciences, Faculty of Health and Social Sciences, Hong Kong Polytechnic University, Hung Hom, Hong Kong
| | - Tsung-Ying Lee
- Institute of Clinical Pharmacy and Pharmaceutical Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Zih-Jie Sun
- Department of Family Medicine, National Cheng Kung University Hospital, Tainan, Taiwan.,Department of Family Medicine, National Cheng Kung University Hospital, Dou-Liou Branch, Dou-Liou, Taiwan.,Department of Family Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Yi-Ching Yang
- Department of Family Medicine, National Cheng Kung University Hospital, Tainan, Taiwan.,Department of Family Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Jin-Shang Wu
- Department of Family Medicine, National Cheng Kung University Hospital, Tainan, Taiwan.,Department of Family Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Huang-Tz Ou
- Institute of Clinical Pharmacy and Pharmaceutical Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan. .,Department of Pharmacy, College of Medicine, National Cheng Kung University, Tainan, Taiwan. .,Department of Pharmacy, National Cheng Kung University Hosiptial , Tainan, Taiwan.
| |
Collapse
|
6
|
Lavernia CJ, Heiner AD, Villa JM, Alcerro JC, Rossi MD. Preoperative Glycemic Control on Total Joint Arthroplasty Patient-Perceived Outcomes and Hospital Costs. J Arthroplasty 2017; 32:6-10. [PMID: 27503695 DOI: 10.1016/j.arth.2016.07.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2016] [Revised: 06/13/2016] [Accepted: 07/05/2016] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND The purpose of this study was to determine the influence of preoperative glycemic control in diabetic patients undergoing a primary total hip or knee arthroplasty. We wanted to study patient-perceived outcomes in the medium term, the length of stay, hospital costs, and rate of short-term postoperative complications. METHODS One hundred twenty consecutive primary total joint arthroplasties (TJAs) performed in type 2 diabetic patients were stratified into 2 groups representing optimal and suboptimal preoperative glycemic control, based on serum levels of glycated hemoglobin (HbA1c), and those groups compared. RESULTS The mean follow-up time was 5.9 years (range, 2.1-10.7 years). Both groups demonstrated improvement in all patient-perceived outcome measures after TJA, with no significant difference detected in any change of a measure between the groups. No significant difference was detected in the length of stay, hospital costs, or rate of short-term postoperative complications between the groups. CONCLUSION Preoperative glycemic control in type 2 diabetic patients undergoing TJA did not affect patient-perceived outcomes in the medium term. Optimal vs suboptimal glycemic control in these patients also had no effect on the length of stay, hospital costs, or rate of short-term postoperative complications.
Collapse
Affiliation(s)
- Carlos J Lavernia
- The Center for Advanced Orthopedics at Larkin Community Hospital, South Miami, Florida
| | - Anneliese D Heiner
- The Center for Advanced Orthopedics at Larkin Community Hospital, South Miami, Florida; Arthritis Surgery Research Foundation, South Miami, Florida
| | - Jesus M Villa
- The Center for Advanced Orthopedics at Larkin Community Hospital, South Miami, Florida; Arthritis Surgery Research Foundation, South Miami, Florida
| | - Jose C Alcerro
- The Center for Advanced Orthopedics at Larkin Community Hospital, South Miami, Florida; Arthritis Surgery Research Foundation, South Miami, Florida
| | - Mark D Rossi
- Department of Physical Therapy, Florida International University, Miami, Florida
| |
Collapse
|
7
|
O'Connor PJ, Sperl-Hillen JM, Margolis KL, Kottke TE. Strategies to Prioritize Clinical Options in Primary Care. Ann Fam Med 2017; 15:10-13. [PMID: 28376456 PMCID: PMC5217839 DOI: 10.1370/afm.2027] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2016] [Revised: 11/18/2016] [Accepted: 11/29/2016] [Indexed: 12/18/2022] Open
Affiliation(s)
- Patrick J O'Connor
- HealthPartners Institute, Minneapolis, Minnesota. HealthPartners Center for Chronic Care Innovation, Minneapolis, Minnesota
| | - JoAnn M Sperl-Hillen
- HealthPartners Institute, Minneapolis, Minnesota. HealthPartners Center for Chronic Care Innovation, Minneapolis, Minnesota
| | - Karen L Margolis
- HealthPartners Institute, Minneapolis, Minnesota. HealthPartners Center for Chronic Care Innovation, Minneapolis, Minnesota
| | - Thomas E Kottke
- HealthPartners Institute, Minneapolis, Minnesota. HealthPartners Center for Chronic Care Innovation, Minneapolis, Minnesota
| |
Collapse
|
8
|
Mosenzon O, Pollack R, Raz I. Treatment of Type 2 Diabetes: From "Guidelines" to "Position Statements" and Back: Recommendations of the Israel National Diabetes Council. Diabetes Care 2016; 39 Suppl 2:S146-53. [PMID: 27440827 DOI: 10.2337/dcs15-3003] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Given the increased prevalence of type 2 diabetes worldwide, most patients are treated by their primary health care team (PHCT). PHCTs need guidance in choosing the best treatment regimen for patients, since the number of glucose-lowering agents (GLAs) is rapidly increasing, as is the amount of clinical data regarding these drugs. The American Diabetes Association/European Association for the Study of Diabetes Position Statement emphasizes the importance of personalized treatment and lists drug efficacy, risk of hypoglycemia, effect on weight, side effects, and cost as important parameters to consider when choosing GLAs. The suggested Israeli guidelines refocus earlier international recommendations from 2012 and 2015, based on emerging data from cardiovascular outcome trials as well as what we believe are important issues for patient care (i.e., durability, hypoglycemia risk, and weight gain).
Collapse
Affiliation(s)
- Ofri Mosenzon
- Diabetes Unit, Division of Internal Medicine, Hadassah Hebrew University Hospital, Jerusalem, Israel
| | - Rena Pollack
- Diabetes Unit, Division of Internal Medicine, Hadassah Hebrew University Hospital, Jerusalem, Israel
| | - Itamar Raz
- Diabetes Unit, Division of Internal Medicine, Hadassah Hebrew University Hospital, Jerusalem, Israel
| |
Collapse
|
9
|
Kuznetsov L, Long GH, Griffin SJ, Simmons RK. Are changes in glycaemic control associated with diabetes-specific quality of life and health status in screen-detected type 2 diabetes patients? Four-year follow up of the ADDITION-Cambridge cohort. Diabetes Metab Res Rev 2015; 31:69-75. [PMID: 24817063 PMCID: PMC4509001 DOI: 10.1002/dmrr.2559] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2013] [Revised: 04/11/2014] [Accepted: 05/07/2014] [Indexed: 01/21/2023]
Abstract
BACKGROUND Interventions that improve HbA1c levels do not necessarily improve health-related quality of life (QoL). This issue may be particularly relevant in asymptomatic diabetes patients detected earlier in the course of the disease. METHODS HbA1c , diabetes-specific QoL (ADDQoL) and health status were measured in 510 screen-detected diabetes patients from the ADDITION-Cambridge trial at 1 and 5 years post diagnosis. Multivariable logistic/linear regression was used to quantify the longitudinal association between change in HbA1c from 1 to 5 years and ADDQoL and health status at 5 years, adjusting for age, sex, education and trial group; alcohol consumption, smoking, physical activity, plasma vitamin C, HbA1c , ADDQoL or health status at 1 year, and glucose-lowering medication at 5 years. RESULTS From 1 to 5 years, median HbA1c interquartile range increased from 6.3% (5.9-6.8) to 6.8% (6.4-7.4); the median ADDQoL score and mean health status physical health summary score decreased from -0.4 (-1 to -0.08) to -0.5 (-1.08 to -0.09) (suggesting an adverse impact of diabetes on QoL) and by -0.79 (8.94) points, respectively. Increases in HbA1c were independently associated with reporting a negative impact of diabetes on QoL (OR = 1.38, 95% CI: 1.03 to 1.85) but not with the health status summary scores. CONCLUSIONS Increases in HbA1c from 1 to 5 years post-diagnosis were independently associated with increased odds of reporting a negative impact of diabetes on QoL. While our results suggest that efforts to reduce HbA1c do not adversely affect health-related QoL, large numbers of participants still report a negative impact of diabetes on their QoL 5 years post-diagnosis.
Collapse
Affiliation(s)
- L Kuznetsov
- MRC Epidemiology Unit, University of Cambridge School of Clinical Medicine, Institute of Metabolic ScienceCambridge, UK
| | - G H Long
- MRC Epidemiology Unit, University of Cambridge School of Clinical Medicine, Institute of Metabolic ScienceCambridge, UK
| | - S J Griffin
- MRC Epidemiology Unit, University of Cambridge School of Clinical Medicine, Institute of Metabolic ScienceCambridge, UK
- The Primary Care Unit, Institute of Public Health, University of CambridgeCambridge, UK
| | - R K Simmons
- MRC Epidemiology Unit, University of Cambridge School of Clinical Medicine, Institute of Metabolic ScienceCambridge, UK
- * Correspondence to: R. K. Simmons, MRC Epidemiology Unit, University of Cambridge School of Clinical Medicine, Box 285 Institute of Metabolic Science, Cambridge Biomedical Campus, Cambridge, CB2 0QQ, UK., E-mail:
| |
Collapse
|
10
|
van der Pols-Vijlbrief R, Dekker JM, Stehouwer CD, de Boer MR, Nijpels G, Snoek FJ, Adriaanse MC. Symptom burden and its association with change in glucose metabolism status over a 7-year period: the Hoorn Study. Diabet Med 2014; 31:747-53. [PMID: 24494697 DOI: 10.1111/dme.12406] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2013] [Revised: 12/02/2013] [Accepted: 01/28/2014] [Indexed: 12/15/2022]
Abstract
AIMS To study symptom burden among older people and its associations with change in glucose metabolism status over a 7-year period. METHODS We conducted a prospective population-based cohort study among 397 older people. We used the revised Diabetes Symptom Checklist to assess symptom burden. Glucose metabolism status was determined using an oral glucose tolerance test. Analyses were adjusted for multiple confounders, including cardiovascular risk and risk of depression (Center for Epidemiological Studies Depression Scale score ≥ 16). RESULTS Revised Diabetes Symptom Checklist total scores (range 0-100) increased slightly over time among people with normal glucose metabolism (mean difference β1.04; P = 0.04) and those with impaired glucose metabolism (β1.96; P = 0.01), but not among people with Type 2 diabetes (β0.46; P = 0.55). These associations between symptom burden and glucose status were attenuated after full adjustment for multiple confounders and remained statistically significant for those with impaired glucose status. Linear mixed models showed significant mean differences in revised Diabetes Symptom Checklist total scores over time when comparing people with Type 2 diabetes with those with normal or impaired glucose metabolism, but not when comparing subjects with impaired vs normal glucose metabolism; these results did not alter after full adjustment. CONCLUSIONS Symptom burden increased gradually over time in the people with impaired glucose metabolism and those with normal glucose metabolism, but not in patients with Type 2 diabetes over a 7-year follow-up period.
Collapse
Affiliation(s)
- R van der Pols-Vijlbrief
- Department of Health Sciences, Faculty of Earth and Life Sciences, VU University, Amsterdam, The Netherlands; EMGO+ Institute for Health and Care Research, VU University Medical Centre, Amsterdam, The Netherlands
| | | | | | | | | | | | | |
Collapse
|
11
|
Reaney M, Mathieu C, Östenson CG, Matthaei S, Krarup T, Kiljański J, Salaun-Martin C, Sapin H, Theodorakis M, Guerci B. Patient-reported outcomes among patients using exenatide twice daily or insulin in clinical practice in six European countries: the CHOICE prospective observational study. Health Qual Life Outcomes 2013; 11:217. [PMID: 24369764 PMCID: PMC3900476 DOI: 10.1186/1477-7525-11-217] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2013] [Accepted: 12/02/2013] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Improvements in the clinical condition of patients with type 2 diabetes are often accompanied by improvements in health-related quality of life and other patient-reported outcomes (PROs), but data assessing injectable treatment initiation from the patient's perspective in routine clinical practice are lacking. We examined PROs in patients initiating injectable treatment in the CHOICE (CHanges to treatment and Outcomes in patients with type 2 diabetes initiating InjeCtablE therapy) study. METHODS CHOICE was a 24-month, prospective observational study conducted in six European countries. Patients initiated exenatide twice daily (BID) or insulin based on a physician's clinical judgement. Clinical and PRO data were collected at baseline (injectable therapy initiation) and after approximately 3, 6, 12, 18 and 24 months. The two treatment cohorts had different baseline characteristics; therefore, no statistical comparisons of endpoints between main cohorts were conducted. RESULTS There were 2388 patients eligible for analysis (exenatide BID cohort, n = 1114; insulin cohort, n = 1274). Mean positive changes in Impact of Weight on Quality of Life-Lite (IWQOL-Lite) total score and EuroQoL5-Dimension (EQ-5D) index and visual analogue scale (VAS) scores were observed in both cohorts with most changes observed during the first 6 months after injectable therapy initiation. Patients who experienced weight loss (≥ 1 kg) at 24 months appeared to have higher mean improvements in IWQOL-Lite total score than did patients with weight gain or no weight change. Patients who met the composite clinical endpoint of glycated haemoglobin (HbA1c) <7.0%, no weight gain (≤ 1 kg) and no hypoglycaemia generally experienced higher mean improvements in EQ-5D index and VAS scores (compared with patients who did not meet this endpoint) and Diabetes Health Profile-18 scores (versus the main cohorts). High levels of missing data were observed for all PRO measures in both cohorts compared with those for clinical outcomes. CONCLUSIONS These data from a clinical practice study support those from clinical trials, suggesting that PROs are not adversely affected, and may be improved, by injectable therapy initiation. PRO data may aid appropriate treatment selection for individual patients. TRIAL REGISTRATION ClinicalTrials.gov, NCT00635492.
Collapse
Affiliation(s)
| | - Chantal Mathieu
- Department of Endocrinology, UZ Gasthuisberg, Leuven, Belgium
| | - Claes-Göran Östenson
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | | | - Thure Krarup
- Department of Endocrinology I, Bispebjerg Hospital, Copenhagen, Denmark
| | | | | | | | - Michael Theodorakis
- Department of Clinical Therapeutics, University of Athens School of Medicine, Athens, Greece
| | - Bruno Guerci
- Diabetologie, Maladies Metaboliques & Nutrition, Hôpital Brabois, CHU de Nancy, et CIC Inserm, ILCV, 54500 Vandoeuvre Lès Nancy, France
| |
Collapse
|